AimTo find evidence to suggest the best approach in patients admitted as an emergency for complicated colorectal cancer.MethodsThe medical records of 131 patients admitted as an emergency with an obstructing, perforated, or bleeding colorectal cancer to Noble’s Hospital, Isle of Man, and the Umberto I University Hospital, Rome, were retrospectively evaluated. Patients were divided in 3 groups on the basis of the emergency treatment they received, namely 1) immediate resection, 2) damage control procedure and elective or semielective resection, and 3) no radical treatment. Demographic variables, clinical data, and treatment data were considered, and formed the basis for the comparison of groups. Primary endpoints were 90-day mortality and morbidity. Secondary endpoints were length of stay, number of lymph nodes analyzed, rate of radical R0 resections, and the number of patients who had chemoradiotherapy.ResultsForty-two patients did not have any radical treatment because the cancer was too advanced or they were too ill to tolerate an operation, 78 patients had immediate resection and 11 had damage control followed by elective resection. There was no statistically significant difference between immediate resections and 2-stage treatment in 90-day mortality and morbidity (mortality: 15.4% vs 0%; morbidity: 26.9% vs 27.3%), number of nodes retrieved (16.6±9.4 vs 14.9±5.7), and rate of R0 resections (84.6% vs 90.9%), but mortality was slightly higher in patients who underwent immediate resection. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection (11.5% vs 36.4%).ConclusionThe present study failed to demonstrate a clear superiority of one treatment with respect to the other, even if there is an interesting trend favoring staged resection.
Background
The status of health of an individual and - more broadly - of a community or population is defined by the status of their determinants of health. A “systemic” approach to define the health determinants is necessary in order to explore the complex relations existing among them. This study is aimed at identifying a ‘composite systemic’ index of health to measure the impact of socioeconomic factors on public health at local level and to analyze possible spatial autocorrelations between neighboring regions.
Methods
A Composite Index of Health (CIH) was constructed on the basis of known indicators of socio-economic well being by using the COMIC (COMposite Indices Creator) Software and was validated on the Italian population and a nationwide comparison has been performed.
Results
Analysis of the determinants showed a significant direct correlation between health, environment, work and wealth and inverse correlation between health and social distress. The analysis of data from Italian provinces confirmed the South-North gradient of well-being.
Conclusions
The CIH is a reliable and robust index to evaluate the health of a local population. Although it was validated on Italian data, the index can be easily adapted to any Country.
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